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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Accident and Health — General Knowledge | ~68% | - Policy Provisions, Clauses & Riders
|
| Topic 2: Nevada Statutes, Rules and Regulations | ~32% | - Nevada Health-Specific Regulations
|
Insurance Licensing인증 InsNV_Health02시험을 가장 빠른 시일내에 가장 쉬운 방법으로 패스하는 방법을 고심초사한끝에 PassTIP에서 연구해 내었습니다. 그건 바로PassTIP의Insurance Licensing인증 InsNV_Health02덤프로Insurance Licensing인증 InsNV_Health02시험에 대비하는것입니다. PassTIP의Insurance Licensing인증 InsNV_Health02덤프품질을 검증하려면 구매사이트의 무료샘플을 체험해보시면 됩니다.자격증을 많이 취득하여 멋진 IT전문가로 되세요.
질문 # 67
A Long-Term Care policy provides coverage for:
정답：D
설명：
Long-term care insurance is designed primarily to cover services required when an insured cannot perform activities of daily living independently or has a severe cognitive impairment. Custodial care in a nursing home is a core example of long-term care coverage. Custodial care involves assistance with everyday personal needs, such as bathing, dressing, eating, transferring, toileting, and continence, rather than acute medical treatment.
Long-term care benefits may be provided in a nursing home, assisted-living setting, adult day-care setting, or the insured's home, depending on the policy. Coverage can include skilled nursing care, intermediate care, custodial care, home health care, hospice care, respite care, and care-management services, subject to policy conditions and benefit triggers.
Hospital-expense and medical-expense policies generally focus on acute treatment, physician services, surgery, hospitalization, and related medical costs. Medicare Supplement insurance is designed to help pay certain Medicare deductibles, coinsurance, and copayments; it is not long-term care insurance.
The distinction is crucial: long-term care insurance addresses prolonged assistance and supervision resulting from chronic illness, disability, frailty, or cognitive impairment, whereas major medical insurance focuses principally on acute medical treatment.
Study Guide references/topics: long-term care insurance; custodial care; skilled care; activities of daily living; nursing-home benefits; Nevada long-term-care regulations .
질문 # 68
Which of the following statements is generally CORRECT about a major medical policy?
정답：A
설명：
Major medical insurance is designed to provide broad protection against substantial medical expenses. It commonly covers hospital, surgical, physician, diagnostic, and other medically necessary services, subject to deductibles, coinsurance, exclusions, and stated policy limits. Therefore, choice D is correct. A major medical policy is not limited to in-hospital expenses; that description is more characteristic of basic hospital coverage.
It also is generally broader-not more limited-than a basic hospital, medical, or surgical policy. A 30-day elimination period is associated more closely with disability income insurance and does not define major medical coverage. The phrase "reasonable and necessary" is important because it allows the insurer to evaluate whether a service was medically appropriate and whether the charge falls within the policy's payment standard. Major medical policies are comprehensive, but they are not unlimited: coverage remains subject to deductibles, coinsurance, exclusions, maximum benefits, network terms, and utilization requirements. Study Guide References/Topics: Types of Health Insurance Policies; Major Medical Expense Insurance; Medical Expense Coverage.
질문 # 69
The Misstatement of Age provision in an Accident and Health policy allows an insurance company to take which of the following actions if an insured has understated the insured ' s age on the policy application?
정답：D
설명：
A Misstatement of Age provision corrects the benefit amount when the insured's age was inaccurately stated at application. If the insured understated age, the premium paid was lower than the premium that should have been paid for the correct age. Rather than canceling coverage or retroactively demanding a different premium, the insurer adjusts the benefit to the amount the premium actually paid would have purchased at the correct age. Choice B is therefore correct. This approach preserves the policy while placing both parties in the financial position contemplated by the policy's age-based premium schedule. The provision does not automatically increase premiums, lapse coverage, or permit cancellation merely because the age was misstated. It is a standard uniform individual accident and health policy provision intended to resolve an administrative error fairly and predictably. The same principle applies in the opposite direction: if age was overstated and excess premium was paid, benefits may be adjusted upward to the amount the paid premium would have purchased at the actual age. Study Guide References/Topics: Policy Provisions, Clauses, and Riders; Uniform Individual Accident and Health Policy Provisions; Misstatement of Age.
질문 # 70
Which of the following statements is correct about the Coordination of Benefits provision?
정답：A
설명：
Coordination of Benefits, commonly called COB, applies when an insured is covered by more than one health plan. It establishes the order in which plans pay and limits the combined payment so the insured does not receive more than the amount of the covered expense. Choice B is correct because COB prevents a profit from duplicate health coverage while still allowing the insured to receive the benefits to which the insured is entitled. One plan is identified as primary and pays first under its policy terms. The secondary plan then considers the unpaid covered balance, subject to its own coordination provisions and limits. COB does not prohibit a person from owning more than one health policy, does not guarantee uninterrupted benefits when changing insurers, and does not authorize a general delay of a workers' compensation claim until benefits expire. Workers' compensation coordination depends on the applicable policy and governing law. On the examination, distinguish COB from nonduplication of benefits and from other insurance clauses; COB specifically allocates payment responsibility among multiple health plans. Study Guide References/Topics:
Group Health Insurance; Coordination of Benefits; Other Insurance Provisions.
질문 # 71
One key distinction between producers and Exchange Enrollment Facilitator (EEF) is producers:
정답：C
설명：
A licensed producer may recommend a health plan for a consumer because the producer is authorized to sell, solicit, and negotiate insurance. That authority permits the producer to discuss coverage choices in a personalized manner, explain how plan provisions apply to the consumer's situation, and recommend a particular policy or plan when appropriate.
An Exchange Enrollment Facilitator is certified to help consumers enroll in qualified health plans through the Exchange. The EEF role is designed to provide impartial enrollment assistance, application support, and general program information. However, an EEF may not sell, solicit, or negotiate insurance. That restriction prevents an EEF from functioning as an insurance producer or steering a consumer toward a particular carrier or plan.
Explaining general terminology, such as deductibles, copayments, and eligibility rules, can be part of enrollment assistance and is not the defining distinction. Compensation is also not the key answer because the legal distinction turns on insurance authority, not simply whether a person receives payment. A Nevada EEF also may not concurrently hold a producer license.
Study Guide references/topics: Exchange Enrollment Facilitators; producer authority; solicitation and negotiation; NRS Chapter 695J .
질문 # 72
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